About Molly Estes, MD FACEP FAAEM

Clerkship Director
Medical Education Fellowship Director
Assistant Professor of Emergency Medicine Loma Linda University

How I Educate Series: Molly Estes, MD

This week’s How I Educate post features Dr. Molly Estes, the Clerkship Director and Medical Education Fellowship Director at Loma Linda University. Dr. Estes spends approximately 80% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. She practices at a university hospital that is a level 1 trauma center, STEMI receiving center, and comprehensive stroke center. Below she shares with us her approach to teaching learners on shift.

Name 3 words that describe a teaching shift with you.

Humorous, practical, stretching.

What delivery methods do use when teaching on shift?

Mostly verbal discussion, the occasional google picture or drawing sketched on the back of my patient list.

What learning theory best describes your approach to teaching?

Socratic. I like to ask a lot of questions to first establish where the learner is at. Then I usually try to help the learner derive their own answer with a series of logical steps. I use a variety of other bedside teaching models too including the One-Minute Preceptor, SPIT, and Teaching Scripts.

What is one thing (if nothing else) that you hope to instill in those you teach?

An inquiring mind :) So much of medicine and medical reasoning is elegant and inspiring, and some of the things we can do are just downright incredible. I hope my learners are able to appreciate the depth of intricacy and sheer coolness of what we do in Emergency Medicine.

How do you balance your flow with on-shift teaching? Does this come at the expense of your documentation?

Most of my teaching is done on an individual basis, is based on the patient being presented, and with very short discussions, typically no longer than 5 minutes at a time. Occasionally if the shift permits it I will gather the learners and do a slightly longer discussion, usually around 10 minutes. This definitely causes documentation to be pushed back sometimes, but in my opinion, it’s worth it.

What is your method for reviewing learners’ notes and how do you provide feedback on documentation?

I try to review notes while on shift, but it more commonly happens after shift. If feedback is needed, I will send an Epic message to the resident or talk to them at conference that same week.

Do you feel departmental flow and metrics adversely affect teaching? What is your approach to excelling at both?

Departmental flow has been challenging to teaching, particularly as our volumes nationwide are getting higher and staffing is getting more stretched. However, teaching is necessary, and I approach it the same way I do any of the other metric requirements of my position. When you look at it as an essential action, then you make sure it gets worked in as best as possible.

It can be difficult to sit back and let senior learners struggle what is your approach to not taking over prematurely?

Literally biting my tongue. I try really hard with my senior residents to let the process happen. Sometimes it’s necessary to step in early, especially when department flow is beginning to suffer a little. But I try to pick the “safe” situations and patients that allow for a bit of the struggle so that those lessons can be applied in the broader context.

Do you start a teaching shift with certain objectives or develop them as a shift unfolds?

Depends on the day, the shift, and the resident. Sometimes we start with goals, other times we don’t.

Do you typically see patients before or after they are presented to you?

After presentations.

How do you boost morale amongst learners on shift?

Trying to rally everyone together as a team. We all need to feel like what we are doing matters, and even if it’s been a disaster of a shift, we have still made a difference to someone. I try to bring the focus back to the positives of the shift, not harping on the negatives.

How do you provide learners feedback?

Typically verbal and either on or immediately after shift. We do end-of-shift evaluations of residents, so I ensure my written feedback always matches with my verbal feedback.

What tips would you give a resident or student to excel on their shift?

Be humble, inquisitive, and challenge yourself to always learn something new from every patient.

Are there any resources you use regularly with learners to educate during a shift?

No one consistent source, but some of the sources I use are UpToDate, WikEM, Medscape, and various FOAMed resources like LITFL, EMCrit, etc.

What are your three favorite topics to teach during a shift?

Dizziness vs. lightheadedness, management of UGIB, and nearly any Heme/Onc topic (yes, I’m quite the nerd with my weird niche interests, haha).

What techniques do you employ when teaching on shift?

One-Minute Preceptor, SPIT, Teaching Scripts, and actually a modified Aunt Minnie model to teach my senior residents department flow as it relates to staffing changes.

Who are three other educators you’d like to answer these questions?

Lizveth Fierro, Andrew Little, Deena Bengiamin.
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Read other How I Educate posts for more tips on how to approach on-shift teaching.

How I Work Smarter: Molly Estes, MD, FACEP, FAAEM

One word that best describes how you work?

Efficiently

Current mobile device

iPhone 11 Pro

Computer

MacBook Air

What is something you are working on now?

This survey :) In seriousness, trying to complete a survey-based study on the effects of virtual rotations on the 2020-21 EM application cycle.

How did you come up with this Idea/Project?

This idea was generated by a subcommittee I am a part of through the Advising Students Committee in EM (ASCEM) through CORD. After brainstorming about the effects that the required conversion to virtual rotations might have had on this year’s students applying into EM, and how residency programs might view or interpret those “clinical experiences,” we decided to try to gather more data to not only help in the development of future virtual rotations but to also help establish a foundation on which virtual rotation experiences might be able to be interpreted.

What’s your office workspace setup like?

Desk with plenty of space for spreading out papers. Elevated second monitor with wireless full keyboard and mouse. Laptop stand for my MacBook to plug into my second monitor.

 

What’s your best time-saving tip in the office or home?

Honestly, upgrading to a second monitor and a full keyboard has made my work-life infinitely better! It allows me to work more efficiently just having more space to have multiple applications or documents open and visible at a time.

What’s your best time-saving tip regarding email management?

Stay on top of it! I try to buy into the “zero-inbox” philosophy. First and foremost, unsubscribe from anything you don’t use/need. Second, any of the “trash” emails you get from your institution, faculty group, etc. that you don’t read or need, immediately delete. Then use separate folders to archive messages you’ve responded to but want to hold onto. I do keep some emails in my inbox that include “to-do” items, but I try to daily or every-other-day clear these out too.

What apps do you use to keep yourself organized?

Nothing fancy, I have a running Google doc that includes to-do lists (for work and daily life), long-running projects with remaining steps (I tend to bold the next immediate step or the absolutely-have-to-do-today action item), or just thoughts and ideas. At the very bottom of my Google doc currently is a list of dim-sum restaurants I want to try :) I basically use this document as a second brain, I offload anything that I don’t want to have to constantly be thinking about.

How do you stay up to date with resources?

For current events, I get a daily email from theSkimm. I also subscribe to Journal Feed to stay on top of highlighted new research and publications. I’m an active member of AAEM, CORD, etc., and routinely go to conferences so I usually don’t have to worry about CME.

What’s your best time-saving tip in the ED?

Two tips. First, use the resources that you have. I lean heavily on my social workers, case managers, ED techs, etc. to help offload tasks (within appropriate means of course, but I don’t have to teach the patient how to use crutches if my tech is available to do it). Second, batch tasks. If you have to walk all the way across the department to check on a patient, make sure you also check on the other two patients along the way. Or instead of following up on each individual lab result, do other tasks for 10-15 minutes then review all your results at the same time. Recruit others to help too. If I need to supervise one of my residents with a procedure, I ask them to get all their supplies at the bedside, and if I’m not there in 15 minutes then to come grab me. It allows you to keep multiple tasks all in parallel processing.

ED charting: Macros or no macros?

Eh…. I’m not a big macro person. I have a standard one I use for general ROS and PE by age, but I don’t have extensive macros for HPI or MDMs.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Some of the best life advice I ever got was at the end of med school: “Not every decision has a right and a wrong answer; sometimes there is just a decision.” I feel like particularly in medicine we are trained to view decisions in a multiple-choice format, a series of “wrong” answers and a single “right” answer. For me personally, this advice was freeing. No longer do I have to agonize over every little thing, I can make a decision accepting that every option has both good and bad built into it, and then move on with my life. I don’t have to spend 10 minutes debating if the appropriate admitting service is Cards or Medicine, I can just choose one and trust that if I happen to be wrong no harm has come to the patient. It wasn’t “wrong” there was just a different option.

  • What advice would you give other doctors who want to get started, or who are just starting out?

It’s worth it! The hard work, the committee you’re not sure you want to be a part of, volunteering for that one thing, saying hello to that one person, it is all worth it. Especially when you are just starting out, don’t be afraid to put yourself out there. Now granted, try hard not to over-commit, that way lies burnout. But you would be surprised by the number of connections you make, the opportunities that come your way, just simply by your being around and available.

  • Is there anything else you’d like to add that might be interesting to readers?

Find yourself, mentors. And I specifically say mentors plural because you need more than one. It’s fine to have a mentor for your personal life, a mentor for your work life, and a mentor for your academic life. But make sure you have people around you to support you and help you keep growing.

Who would you love for us to track down to answer these same questions?

  • Tim Young, MD @timpyoung
  • Liz Fierro, MD @liz_fierro_md

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

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